Aetna Clarifies 97001/97002 Not Included in Policy Change

In communication with New York Chapter leaders, Aetna has clarified that 97001 and 97002 are not included in a policy change published on page 2 in its September 2012 OfficeLink Updates™.

The publication includes an updated policy for evaluation and management codes billed by certain nonphysician provider types, which becomes effective December 1. The policy states that evaluation and management codes will not be allowed for physical therapists, occupational therapists, speech therapists, audiologists, dieticians, and nutritionists. Aetna representatives have confirmed that the policy applies to codes in the 992xx series, and will not be billable by physical therapists. However, physical therapists will continue to be able to report 97001 and 97002 for evaluation and reevaluation.

I no longer accept Aetna, nor Cigna, nor any private carrier. Patients must pay at the time of visit, then we bill their carrier electronically. If payment comes, we remit reimbursement to the client. However, it is interesting that some companies will use Aetna, Cigna, etc. for management purposes only for their "self insured" programs, and their reimbursements, depending on what the company chooses for their employees, can vary between 75-100% of OUR CHARGES. But, when there is no self insured company which is backing Aetna, Cigna, etc.'s management of the program, and it is an individual policy or company provided policy paying premiums to them, the reimbursements are in the 50-75% of the MEDICARE fee schedule. This is why I encourage P.T.'s to take only the plans that pay a fair rate and otherwise, require payment at the time of visit and offer to submit for the client and pay them what the company has paid if it's less than the client paid, or give them their money back and keep the remittance if it is more than what the client paid. This has been the only way I could survive in a small practice.

Posted by Larry
on 8/31/2012 9:13 PM

Larry, what state are you practicing in? The idea is certainly more profitable for us and leads to fair rates, however I find that patients are not able to pay medicare fee schedule rates up front or at all.

Posted by Anthony
on 9/2/2012 10:00 AM

Larry ,
I have often thought of follwing this same model. How many patients do you see a week and with how many on staff. What state are you practicing in? and does it affect your referrals from MD's ? Thanks in advance! Good luck ! Donna